By James Panter
In late 1999, seven-year-old Spencer H. was trying to cope with severe asthma
and allergies that made him so miserable he didn’t want to go outside.
After he had endured several stays in the hospital and a relentless routine
of prescribed medications, his mother looked for a better solution.
She drove her son to Frankfort, Ky., to Louisville’s Kentuckiana’s
Children’s Center, where Dr. Eric Epstein, a volunteer chiropractor, evaluated
him and developed a specialized care plan—including two or three visits
per week for the first three months. Over the past three years, the plan has
produced dramatic results. Spencer is now an active 10-year-old.
“Within two months of beginning care at the center, he was off all of his
drugs, except for an occasional use of the inhaler,” said Epstein. “By
the end of his first year of care, Spencer was able to participate in swimming
and soccer and was missing 4 to 6 days of school instead of 20. Currently, the
only problems he has are an occasional tightness in his chest and sneezing,
and we address those things on an as-needed basis.”
Since 1957 Kentuckiana Children’s Center has provided individualized programs
designed to help children who are physically and mentally challenged and who
have chronic cases that require time, sustained care and understanding. Services
are provided to families regardless of their ability to pay and most patients
are from low- to moderate-income families.
A Comprehensive Approach
Founded by Dr. Lorraine Golden, the private, nonprofit center has a multidisciplinary
staff that operates an outpatient clinic and offers educational programs. Its
work provides a research basis for advancing pediatric chiropractic, particularly
since the types of cases presented to Kentuckiana have changed.
“Seventy-five percent of our cases fall in the autistic spectrum and about
25 percent are either Down’s syndrome, cerebral palsy, epilepsy or other
conditions,” notes Executive Director Jean Elizabeth. “When the center
first opened, the majority of the clients had Down’s syndrome or cerebral
palsy.”
Golden, a Palmer School of Chiropractic graduate, served as executive administrator
until her retirement in 1998. In 1961, she obtained the deed to 11.23 acres
of land and six buildings for Kentuckiana through a federal grant from the U.S.
Department of Health, Education and Welfare. Today, the center operates five
days a week and offers, in addition to chiropractic, psychological and social
evaluations and counseling, optometric and visual training, dietary analysis,
referrals for medical and dental care and special education classes.
Dr. Sharon A. Vallone serves as chairwoman of the board of directors for Kentuckiana,
which occupies a 5,044-square-foot facility that can provide care for 125 children
per week. It has three chiropractic adjusting and exam rooms; a craniosacral
and massage therapy room; X-ray and development rooms; rooms for therapeutic
movement and art and play therapy; plus administrative offices and offices for
nutrition counseling and social services.
Currently, Kentuckiana has four clinic staff members, three administrative staff
members and five volunteers, including three D.C.s: a social work clinician,
certified movement therapist, and a registered and licensed dietitian is on
staff.
Client referrals come from throughout the world from parents, schools, day care
providers, agencies and doctors from both medical and chiropractic practices.
The center also receives inquiries through its web site (www.kentuckiana.org).
Services have been provided to children from the United States, Canada, Puerto
Rico and India. The Ronald McDonald House, in Louisville, has provided housing
for patients and their families while under an intensive care plan.
Dr. Celeste Krawchuk, a 1996 National College of Chiropractic graduate, left
private practice to become a full-time clinic doctor at Kentuckiana.
“I love working with children,” she notes, “and I liked getting
back to the basics of chiropractic. With the special needs children, just seeing
slight improvements, even in their facial expressions, from week to week, is
giving me a whole lot more (fulfillment).”
Each week, she manages care for 12 to 20 children and 75 percent of her patients
are autistic, which Krawchuk says has necessitated a change in her approach.
“I’ve had to learn to deal with non-verbal kids and depend on their
parents for the information, rather than getting a lot of the information directly
from the kids,” she describes. “In private practice, I depended on
what the patients were telling me and whether they were being compliant. Now,
it’s more dependent on the parents. Once I’ve palpated and adjusted
the child, I can get a lot of information.”
Even when I child’s trust has been gained, the process can be a lengthy
one.
“In some of them, we do see immediate results, and for others, it’s
a time factor,” she adds. “You can tell a difference in the way they’re
walking or behavior or their body functions. Each child is unique and just helping
each one of them to the best of my ability is what my focus is right now.”
Krawchuk, who uses Diversified, Gonstead and Activator techniques, delivers
specific care in intensive sessions three days a week for four weeks. Evaluations
are made to determine the need for craniosacral therapy, movement therapy, play
and art therapy and nutritional counseling.
Analysis and Care Planning
The center now has 185 active cases and typically sees between 12-20 patients
a day.
“Prior to the initial consultation with the parents and the child’s
examination, the parents are sent a detailed patient history form to complete
and mail back to Kentuckiana,” Epstein explains. “This form includes
information on the mother’s pregnancy, the birth, infancy, age related
milestones, health history of the child, including medications, nutritional
and diet information as well as any concerns the parents may have concerning
their child’s development. From this information, the doctor can begin
to outline a care plan.”
The initial full examination of the child includes height, weight, temperature,
review of systems and chiropractic and neurological exams. A trace mineral analysis
of the hair may be performed, which involves lab testing metal and mineral toxicity.
The care plan is divided into four phases: intensive, remobilization, remodeling
and supportive.
“The plan is tailored to each child’s special needs,” notes Krawchuk.
“We begin with chiropractic adjustments and recommend a meeting with our
nutritionist and possibly craniosacral or massage or movement therapists. We
conduct a re-evaluation at approximately six weeks into the plan to evaluate
how the child is responding and recommend changes if necessary.”
The doctor monitors the plan and gets input from other specialists to adjust
it accordingly. Parents are educated about chiropractic and its benefits and
are informed about the child’s progress.
“The most difficult cases are the ones where profoundly affected children
are not able to comply with dietary changes and where exercise is difficult
or impossible,” says Epstein. “It is often hard for a family to adjust
to the dietary needs of one child under treatment immediately. However, this
may hinder the progress.”
Nutrition is a main concern in some cases. Rachel C., a 7-year-old currently
making two visits per week, is under active care for Prader-Willi disease.
“It is a genetic disorder,” describes Epstein. “It is on the
autism spectrum and it is accompanied by an inability to perceive the sensation
of being full when you’ve eaten. In very severe cases, these kids have
to be locked in their rooms and sometimes restrained because they’ll get
up in the middle of the night and eat pencil shavings or rubber or whatever
happens to be around them.
“Rachel is not as profoundly affected at that,” he continues. “She’s
not an obese child, as many of these children are. Her primary issues are low
muscle tone, ADHD-like behaviors and sensory problems. You cannot touch the
back of her head because she goes into a fury. She is getting craniosacral therapy
and movement therapy and she has nutritional counseling once a week.”
Rachel is on a special gluten-free, casein-free diet, which the center recommends
for autistic children. It is an innovative approach designed to counter the
disease’s effects.
“It does much better for some children than for others,” Epstein states.
“The theory is that, for some reason, there are large protein fragments
that are not broken down in the gastrointestinal system of these children. These
protein fragments are then absorbed by the bowels when they should not be. That,
in turn, causes the body to launch an auto-immune reaction, creating antibodies
that, in the case of children with autism, attack the elements of the brain
that are affected. So this diet eliminates these elements.”
The overall success of the care plan depends on the bond made between doctor
and child.
“We really the spend the first phases of our care getting to know the child,
getting to appreciate their comfort zone and making friends and gaining trust
with them,” says Epstein. “What has really surprised me most, especially
about autism, is that I’d always been told that autistic children were
very remote and removed and emotion-free. Yet many of our kids are the most
lovable on the planet, and they really need affection.”
With autistic patients, Kentuckiana doctors also sometimes implement activities
such as rebounding—a technique which uses boots with built-in springs—to
help the children get in touch with their surroundings.
“Our intention is to drive as much coherent information into the brain
as we can,” Epstein explains, “because these kids spend so much time
out of touch with reality or incoherent.”
Fund-Raising Efforts
Such specialized care requires funding and Kentuckiana receives donations from
individuals, civic and religious groups, businesses, labor unions, employee
funds, foundations, bequests, professionals, professional associations and auxiliaries,
schools and the center’s own in-house auxiliary.
The center’s annual budget for Kentuckiana Children’s Center is $404,200.
Chiropractic offices hold special fund-raising events, such as spinal screenings,
Kids Day America or educational programs, to raise money. The center’s
major fund-raising event each year is the “Fore The Kids” Golf Marathon,
where golfers play 100 holes of golf from dawn to dusk in one day. The center
also solicits donations of new or gently-used equipment, which must have prior
approval before acceptance.
So what are Kentuckiana’s plans for the future?
The center is planning a “Children’s Day In” Program, where parents
can drop their children off for care, as a step in setting up a day-care program.
Kentuckiana is also expanding its outreach to low-income areas of Louisville
to offer chiropractic services to those who cannot afford it.
“We are currently investigating some research opportunities within the
scope of ADHD and the autistic spectrum disorders,” states Jean Elizabeth.
“Creating collaborative projects with outside agencies is a way we see
to further educate others about the importance of pediatric chiropractic.”
About the author: James Panter is editor of Today’s Chiropractic.
© Copyright 2002 Today's Chiropractic